Vancomycin hypersensitivity reactions need better documentation

Vancomycin is the most commonly used antimicrobial in U.S. hospitals, yet research shows that electronic health records (EHR) do a poor job of documenting patients’ hypersensitivity reactions (HSRs) to the agent. Most systems have coded entries for at least some HSRs, but other reactions require free-text documentation. The new study consulted the EHR allergy module of the Mass General Brigham (MGB) and Johns Hopkins Health System (JHHS) Corporation databases to investigate the epidemiology of vancomycin HSRs during 2017–19. Led by Kimberly G. Blumenthal, MD, of Massachusetts General Hospital and Harvard Medical School, the researchers determined that 0.32% of JJHS patients and 0.31% of MGB patients had an active vancomycin drug allergy label in their EHR. Rash was most common, followed by “red man syndrome (RMS),” hives, itching, flushing, and anaphylaxis. About 6% of all HSRs cited anaphylaxis, although Blumenthal noted that true cases are “exceedingly rare.” Her team also observed that RMS was the most common free-text entry; but for more than one-quarter of RMS patients, the reaction was coded simply as “other.” Among 10,000-plus patients with possible RMS, odds of RMS documentation were 30% higher for men than women and 41% lower for Blacks than for Whites. Study co-author Santiago Alvarez-Arango of Johns Hopkins University stated in an email, “Moving forward, we need standardization in the way that drug allergies are documented.” The study findings are reported in the Journal of Allergy and Clinical Immunology: In Practice.